Digital Breast Tomosynthesis

20.2.1 - Digital Breast Tomosynthesis (Rev. 3844, Issued: 08-18-17, Effective: 01-01-18, Implementation: 01-02-18) A. Screening Breast Tomosynthesis Effective for claims with dates of service January 1, 2017 through December 31, 2017, HCPCS code 77063, “Screening Digital Breast Tomosynthesis, bilateral, must be billed in conjunction with the primary service mammogram code G0202. Effective for claims with dates of service January 1, 2018 and later HCPCS code 77063, “Screening Digital Breast Tomosynthesis, bilateral, must be billed in conjunction with the primary service mammogram code 77067. A/B MACs (A) and (B) must assure that claims containing code 77063 also contain HCPCS code 77067* (G0202*). A/B MACs (A) return claims containing code 77063 that do not also contain HCPCS code 77067* (G0202*)with an explanation that payment for code 77063 cannot be made when billed alone. A/B MACs (B) deny payment for 77063 when billed without 77067* (G0202*). NOTE: When screening digital breast tomosynthesis, code 77063, is billed in conjunction with a screening mammography, code 77067* (G0202*), and the screening mammography 77067* (G0202*) fails the age and frequency edits in CWF, both services will be rejected by CWF. B. Diagnostic Breast Tomosynthesis Effective with claims with dates of service January 1, 2017 through December 31, 2017 HCPCS code G0279, “Diagnostic digital breast tomosynthesis, unilateral or bilateral”, must be billed in conjunction with the primary service mammogram code G0204 or G0206. Effective with claims with dates of service January 1, 2018 and later, HCPCS code G0279, “Diagnostic digital breast tomosynthesis, unilateral or bilateral”, must be billed in conjunction with the primary service mammogram code 77065 or 77066.Effective for claims with dates of service January 1, 2017 through December 31, 2017 A/B MACs (A) and (B) must assure that claims containing code G0279 also contain HCPCS code G0204 or G0206. A/B MACs (A) or (B) deny claims containing code G0279 that do not also contain HCPCS code G0202 or G0206 with an explanation that payment for code G0279 cannot be made when billed alone. Effective for claims with dates of service January 1, 2018 and later A/B MACs (A) and (B) must assure that claims containing code G0279 also contain HCPCS code 77065 or 77066. A/B MACs (A) or (B) deny claims containing code G0279 that do not also contain HCPCS code 77065 or 77066 with an explanation that payment for code G0279 cannot be made when billed alone. Claims for diagnostic breast tomosynthesis, HCPCS code G0279, submitted with a revenue code other than 0401, 096X, 097X, or 098X will be return to providers. Claims for diagnostic breast tomosynthesis, HCPCS code G0279, submitted with a TOB other than 12X, 13X, 22X, 23X, or 85X will be return to providers.